Cavernous sinus thrombosis physical examination: Difference between revisions

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==Overview==
==Overview==
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high grade fever, [[Tachycardia]] with regular pulse, [[Tachypnea|Tachypnea, l]]<nowiki/>ow blood pressure with normal pulse pressure, [[Pallor]] of skin, [[Altered mental status]], [[Periorbital edema]] (initially unilateral but typically bilateral), unilateral or bilateral [[exophthalmos]], abnormal extra-ocular movements from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy, non-reactive [[Pupil|pupils]] to neither light nor accommodation (from [[paralysis]] of the iris and [[ciliary body]]), lid [[erythema]], [[Horner's syndrome|horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]]), [[Chemosis]], [[Ptosis]], [[Proptosis]] (due to impaired venous drainage of [[orbit]], painful eye movement, [[Papilledema]], [[Retinal haemorrhage|retinal hemorrhages,]] decreased [[visual acuity]], [[Photophobia]], pulsating [[conjunctiva]], facial tenderness, impaired [[corneal reflex]], [[Blindness|blindness,]] [[Neck stiffness|stiff neck,]] [[Photophobia]], [[Hyperreflexia]], [[Weakness|generalised weakness]], downgoing [[plantar reflex]], [[Ptosis]] and [[Hemiparesis]].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with cavernous sinus thrombosis usually appear very ill and toxic.<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*High-grade fever<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]]<ref name="pmid27594955">{{cite journal| author=Sacchetti F, Stagni S, Spinardi L, Raumer L, Dentale N, Cirillo L| title=A singular case of cavernous internal carotid artery aneurysm in patient with cavernous sinus syndrome and bacterial meningitis. | journal=Radiol Case Rep | year= 2016 | volume= 11 | issue= 3 | pages= 227-33 | pmid=27594955 | doi=10.1016/j.radcr.2016.05.005 | pmc=4996927 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27594955  }} </ref>
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Low blood pressure with normal pulse pressure
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
=== Skin ===
* Skin examination of patients with [disease name] is usually normal.
* [[Pallor]] may be present<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.<gallery widths="150px">
* [[Periorbital edema]] (initially unilateral but typically bilateral)<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid20009315">{{cite journal| author=Senthilkumaran S, Balamurgan N, Arthanari K, Thirumalaikolundusubramanian P| title=Periorbital swelling in emergency room: Get your eyes in. | journal=J Emerg Trauma Shock | year= 2009 | volume= 2 | issue= 3 | pages= 209-10 | pmid=20009315 | doi=10.4103/0974-2700.55349 | pmc=2776373 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20009315  }} </ref>
 
* Unilateral or bilateral [[exophthalmos]]<ref name="pmid27401467">{{cite journal| author=Kamawal A, Schmidt MA, Rompel O, Gusek-Schneider GC, Mardin CY, Trollmann R| title=[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]. | journal=Ophthalmologe | year= 2017 | volume= 114 | issue= 5 | pages= 457-461 | pmid=27401467 | doi=10.1007/s00347-016-0317-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401467  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
UploadedImage-01.jpg | Description {{dermref}}
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
UploadedImage-02.jpg | Description {{dermref}}
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
 
*[[Pupil|Pupils]] non-reactive to neither light nor accommodation (from [[paralysis]] of the iris and [[ciliary body]])<ref name="pmid22802153" />
</gallery>
*Lid [[erythema]]<ref name="pmid22802153" />
OR
*[[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
* Abnormalities of the head/hair may include ___
*[[Chemosis]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
* Evidence of trauma
*[[Ptosis]]<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
* Icteric sclera
*[[Proptosis]] (due to impaired venous drainage of [[orbit]])<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
* [[Nystagmus]]  
*Painful eye movement<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
* Extra-ocular movements may be abnormal
*[[Papilledema]]<ref name="pmid22802153" />
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*[[Retinal haemorrhage|Retinal hemorrhages]]<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
*Ophthalmoscopic exam may be abnormal with findings of ___
*Decreased [[visual acuity]]<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
* Hearing acuity may be reduced
*[[Photophobia]]<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref>
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*Pulsating [[conjunctiva]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* Facial tenderness<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
* [[Exudate]] from the ear canal
* Impaired [[corneal reflex]]<ref name="pmid22802153" /><ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
* [[Blindness]]<ref name="pmid2685213">{{cite journal| author=Ogundiya DA, Keith DA, Mirowski J| title=Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. | journal=J Oral Maxillofac Surg | year= 1989 | volume= 47 | issue= 12 | pages= 1317-21 | pmid=2685213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2685213  }} </ref><ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*[[Neck stiffness|Stiff neck]] may be present.<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with cavernous sinus thrombosis is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with cavernous sinus thrombosis is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with cavernous sinus thrombosis is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with cavernous sinus thrombosis is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with cavernous sinus thrombosis is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Altered mental status]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
OR
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
*Patient is usually oriented to persons, place, and time
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
* Altered mental status
* [[Photophobia]]<ref name="pmid14128709">{{cite journal| author=PASCARELLI E, LEMLICH A| title=DIPLOPIA AND PHOTOPHOBIA AS PREMONITORY SYMPTOMS IN CAVERNOUS SINUS THROMBOSIS. | journal=Ann Otol Rhinol Laryngol | year= 1964 | volume= 73 | issue=  | pages= 210-7 | pmid=14128709 | doi=10.1177/000348946407300123 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14128709  }} </ref>
* Glasgow coma scale is ___ / 15
* [[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
* Clonus may be present
* [[Hyperreflexia]]<ref name="pmid27928303">{{cite journal| author=Ekinci M, Çağatay HH, Hüseyinoğlu N, Ceylan E, Gökçe G| title=Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report. | journal=Neuroophthalmology | year= 2014 | volume= 38 | issue= 4 | pages= 220-223 | pmid=27928303 | doi=10.3109/01658107.2013.874453 | pmc=5123155 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27928303  }} </ref>
* Hyperreflexia / hyporeflexia / areflexia
* [[Weakness|Generalised weakness]]<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref>
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
*Decreased [[visual acuity]]<ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>
* Muscle rigidity
*Downgoing [[plantar reflex]]<ref name="pmid29441008">{{cite journal| author=Luo Y, Tian X, Wang X| title=Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. | journal=Front Aging Neurosci | year= 2018 | volume= 10 | issue=  | pages= 2 | pmid=29441008 | doi=10.3389/fnagi.2018.00002 | pmc=5797620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29441008  }} </ref>
* Proximal/distal muscle weakness unilaterally/bilaterally
*[[Ptosis]]<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*[[Hemiparesis]]<ref name="pmid29441008">{{cite journal| author=Luo Y, Tian X, Wang X| title=Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. | journal=Front Aging Neurosci | year= 2018 | volume= 10 | issue=  | pages= 2 | pmid=29441008 | doi=10.3389/fnagi.2018.00002 | pmc=5797620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29441008  }} </ref>
*Unilateral/bilateral upper/lower extremity weakness
* [[Blindness]]<ref name="pmid2685213">{{cite journal| author=Ogundiya DA, Keith DA, Mirowski J| title=Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. | journal=J Oral Maxillofac Surg | year= 1989 | volume= 47 | issue= 12 | pages= 1317-21 | pmid=2685213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2685213  }} </ref><ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with cavernous sinus thrombosis is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 15:42, 5 July 2018

Cavernous sinus thrombosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high grade fever, Tachycardia with regular pulse, Tachypnea, low blood pressure with normal pulse pressure, Pallor of skin, Altered mental status, Periorbital edema (initially unilateral but typically bilateral), unilateral or bilateral exophthalmos, abnormal extra-ocular movements from third, fourth and sixth cranial neuropathy, non-reactive pupils to neither light nor accommodation (from paralysis of the iris and ciliary body), lid erythema, horner syndrome (ptosis, miosis, and anhidrosis), Chemosis, Ptosis, Proptosis (due to impaired venous drainage of orbit, painful eye movement, Papilledema, retinal hemorrhages, decreased visual acuity, Photophobia, pulsating conjunctiva, facial tenderness, impaired corneal reflex, blindness, stiff neck, Photophobia, Hyperreflexia, generalised weakness, downgoing plantar reflex, Ptosis and Hemiparesis.

Physical Examination

Appearance of the Patient

  • Patients with cavernous sinus thrombosis usually appear very ill and toxic.[1][2][3]

Vital Signs

Skin

HEENT

Neck

Lungs

  • Pulmonary examination of patients with cavernous sinus thrombosis is usually normal.

Heart

  • Cardiovascular examination of patients with cavernous sinus thrombosis is usually normal.

Abdomen

  • Abdominal examination of patients with cavernous sinus thrombosis is usually normal.

Back

  • Back examination of patients with cavernous sinus thrombosis is usually normal.

Genitourinary

  • Genitourinary examination of patients with cavernous sinus thrombosis is usually normal.

Neuromuscular

Extremities

  • Extremities examination of patients with cavernous sinus thrombosis is usually normal.

References

  1. ↑ 1.0 1.1 1.2 Goh KG, Shanthi V (2015). "The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report". Malays J Med Sci. 22 (5): 98–102. PMC 5295744. PMID 28239275.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Arian M, Kamali A, Tabatabaeichehr M, Arashnia P (2016). "Septic Cavernous Sinus Thrombosis: A Case Report". Iran Red Crescent Med J. 18 (8): e34961. doi:10.5812/ircmj.34961. PMC 5068248. PMID 27781123.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Xia P, Jiao Y (2014). "Septic cavernous sinus thrombosis caused by tuberculosis infection". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-206209. PMC 4248139. PMID 25425249.
  4. ↑ Sacchetti F, Stagni S, Spinardi L, Raumer L, Dentale N, Cirillo L (2016). "A singular case of cavernous internal carotid artery aneurysm in patient with cavernous sinus syndrome and bacterial meningitis". Radiol Case Rep. 11 (3): 227–33. doi:10.1016/j.radcr.2016.05.005. PMC 4996927. PMID 27594955.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 Visvanathan V, Uppal S, Prowse S (2010). "Ocular manifestations of cavernous sinus thrombosis". BMJ Case Rep. 2010. doi:10.1136/bcr.08.2009.2225. PMC 3028264. PMID 22802153.
  6. ↑ Senthilkumaran S, Balamurgan N, Arthanari K, Thirumalaikolundusubramanian P (2009). "Periorbital swelling in emergency room: Get your eyes in". J Emerg Trauma Shock. 2 (3): 209–10. doi:10.4103/0974-2700.55349. PMC 2776373. PMID 20009315.
  7. ↑ Kamawal A, Schmidt MA, Rompel O, Gusek-Schneider GC, Mardin CY, Trollmann R (2017). "[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]". Ophthalmologe. 114 (5): 457–461. doi:10.1007/s00347-016-0317-6. PMID 27401467.
  8. ↑ 8.0 8.1 8.2 8.3 Sweis R, Biller J (2016). "Cavernous Sinus Thrombosis in Children". Pediatr Neurol Briefs. 30 (1): 4. doi:10.15844/pedneurbriefs-30-1-3. PMC 4798854. PMID 27004138.
  9. ↑ 9.0 9.1 Ogundiya DA, Keith DA, Mirowski J (1989). "Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature". J Oral Maxillofac Surg. 47 (12): 1317–21. PMID 2685213.
  10. ↑ 10.0 10.1 10.2 Sharma S, Cruess AF (1996). "Central retinal vein occlusion associated with cavernous sinus thrombosis". Can J Ophthalmol. 31 (5): 255–6. PMID 8872381.
  11. ↑ PASCARELLI E, LEMLICH A (1964). "DIPLOPIA AND PHOTOPHOBIA AS PREMONITORY SYMPTOMS IN CAVERNOUS SINUS THROMBOSIS". Ann Otol Rhinol Laryngol. 73: 210–7. doi:10.1177/000348946407300123. PMID 14128709.
  12. ↑ Ekinci M, Çağatay HH, Hüseyinoğlu N, Ceylan E, Gökçe G (2014). "Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report". Neuroophthalmology. 38 (4): 220–223. doi:10.3109/01658107.2013.874453. PMC 5123155. PMID 27928303.
  13. ↑ 13.0 13.1 Luo Y, Tian X, Wang X (2018). "Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review". Front Aging Neurosci. 10: 2. doi:10.3389/fnagi.2018.00002. PMC 5797620. PMID 29441008.

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